Actinic cheilitis

Actinic cheilitis Definition

It is an inflammatory condition of the lips that has a high potential of developing into squamous cell carcinoma. The disorder is analogous to actinic keratosis, a precancerous condition of the skin marked by solar-induced lesions. Actinic cheilosis is the other name of this condition. It is sometimes known as “farmer’s lip” or “sailor’s lip”.

Actinic cheilitis Symptoms

The condition most often affects the lower lip. At the beginning of the disorder the vermilion border, which is the sharp demarcation between the red colored lip and the adjacent normal skin, begins to fade and gives rise to a prominent painless lesion. The lips harden and get covered with scaly deposits. Some of the other noticeable symptoms of the pre-malignant disorder include:

Dry and cracked lips

Redness

Whitish discoloration at the border of the lip

Formation of crusty bumps

Persistent erosions

Puffiness

Actinic cheilitis Causes

The predominant cause of the condition is chronic exposure to the ultraviolet rays from the sun. The radiant energy is capable of initiating a chemical reaction in the cutaneous tissues and subsequent photobiological changes. Besides solar radiation, the condition can also occur due to any of the following reasons:

Regular use of tobacco

Application of allergen-containing lip balms, causing irritation

Poor oral hygiene

Ill-suited dentures

Actinic cheilitis Diagnosis

Patients who have been habitually exposed to sunlight are more likely to be detected with this condition. Doctors can also suspect the pre-cancerous ailment in individuals with a history of tobacco consumption as well smoking. It is very important for the affected patients to inform their healthcare providers about any past cases of allergic or dental disorders. The presence of a crusty lesion(s) near a discolored vermilion border along with other manifestations on the lower lip forms the basis of diagnosis. Further assessment of the characteristic lump can be performed with a biopsy. It is mandatory to conduct a microscopic examination of the lesion since the condition has a greater chance of transforming into a malignant disease. If necessary, physicians may order for some more tests to exclude the presence of other disorders.

Actinic cheilitis Treatment

Following are some of the treatment options for this condition:

5-fluorouracil

It is a topical medication applied to the affected skin lesions as a thin coating. 5-FU has the ability to permeate into deeper skin layers and subsequently block DNA synthesis. The premalignant cells undergo proliferation, and need DNA for further growth due to which they accumulate more 5-FU and die. For effective results, 2-4 weeks of treatment with the topical ointment is required. In about 50% of patients, the lesions disappear completely. However, it may lead to few side effects like:

Burning

Inflammation

Exudation

Erosion

Ulcers

Scarring

Imiquimod

It is an immune stimulator that causes spontaneous death of the tumor cells. When the immune system undergoes modification the monocytes are released to invade the epidermis, resulting in erosion. T lymphocytes also play a significant role in this case. Most patients achieve complete clearance with minimal scarring.

Scalpel vermillionectomy

In this invasive procedure, a portion of the vermillion ridge is removed without disturbing the underlying muscle. Although scarring of the lip is unavoidable, it can be reduced with the help of steroids and massage. The method is highly effective and has a less recovery time.

Chemexfoliation

In this treatment, a chemical solution with 50% trichloroacetic acid is applied to the affected tissue, which causes it to blister and eventually peel off. The new, regenerated skin is usually smoother and lesion-free. However, the lip becomes temporarily more sensitive to the sun.

Electrosurgery

In this technique, a high-frequency electric current is applied on the affected region to destroy the premalignant lesion. Electrosurgery may involve destruction of adjacent tissues and scarring. Therefore, local anesthesia prior to the treatment must be given to the patients.

Cryosurgery

The method is suitable for small lesions, which generally involves the application of liquid nitrogen as an open spray. Administration of local anesthesia is usually not preferred, but could be required in the treatment of the entire lip to negate the pain.

Carbon dioxide laser vaporization

The affected vermillion border is subjected to the laser therapy for early remission of the lesions. Post treatment the affected patients are vulnerable to secondary infection and scarring. It may take more than three weeks for the tissues to heal completely.

Actinic cheilitis Risk Factors

Abnormal intolerance to UV light is often seen in fair-skinned adults and older males. Susceptibility to this condition is mainly attributed to the presence of less melanin.

In about 10% of cases of actinic cheilitis, patients develop squamous cell carcinoma. However, the treatment options are curative and present a low rate of recurrence. Seek immediate advice from a healthcare provider if you notice any abnormal changes near or on the lip margins.